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Adult Acne & Polycystic Ovarian Syndrome (PCOS)

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Adult Acne & Polycystic Ovarian Syndrome (PCOS)

So, you are a lady now. Not a teenage girl, but a grown woman. So why the f%#k are you still getting acne? The answer to this predicament is both individual and complex. Statistics show that there is actually a worldwide increase in cases of female acne, with over 50% of women over the age of 25 experiencing acne - and most arrows point towards hormones. There are several hormonal conditions that could be the cause but first up we are going to talk about Polycyctic Ovarian Syndrome. If you or someone you know has been struggling with adult acne, weight gain, hair thinning on the head, or extra hairiness on the body....read on.

 

What is it?

Polycystic ovarian syndrome is a hormonal disorder that can effect women of reproductive age. Like with any condition labelled a “syndrome” diagnosis can depend on the criteria used (different criteria is used in different countries), however it is estimated that in Australia between 12-21% of women have PCOS with potentially, with up to 70% of these remaining undiagnosed (Boyle & Teede, 2012).

 

Signs

Diagnostics signs of PCOS include the following:

  ~ Oligo-anovulation: Basically irregular periods, that can also present as infertility.

 ~ Ovarian Cysts: Present via an ultrasound.

 ~ Hyperandrogenism: High levels of the hormones Testosterone and DHEA-S.

Diagnosis requires you to have the presence of two of three of the above criteria, and it is important to rule out any other hormonal imbalances e.g. Thyroid disorders, Cuching's Syndrome etc.

One important sign missing from current diagnostics is the presence insulin resistance, which has been shown to be more prevalent in women with PCOS whether they are obese or non-obese compared to women without PCOS.

 

Symptoms

The above diagnostic signs are a little difficult to know unless you have had a medical examination, however there are some symptoms that you may recognise here they may be indicative of PCOS.

 

Symptom

Examples

Cause

Hirsutism  (Abnormal hair growth)

Noticeable facial hair on the upper lip, jaw line, thighs, back, stomach and lower back. Usually dark and thick.

Elevated androgen hormones: testosterone and DHEA-S & high insulin

Acne

Acne of face, jaw, neck or back that flares up prior to menstruation.

Due to increased androgens and insulin resistance.

Weight gain

Particularly extra abdominal fat around the waist that is difficult to get rid of

Due to increased insulin levels 

Alopecia

Hair thinning or balding on the head.

Elevated androgen hormones: testosterone and DHEA-S

Ovulation pain

 

Mid-cycle pain present with ovulation

Can be a sign of cysts in the ovaries due to high insulin

Amenorrhea

Irregular or absent periods

 

Due to presence of ovarian cysts and / or hormonal imbalance affecting egg growth.

Abnormally increased libido

High sex drive especially around time of ovulation

 

High sex drive is due to high testosterone.

 

 

Abnormally decreased libido

Lack of sex drive

Decreased libido can be due to depression caused by lack of body confidence or fatigue to do altered blood sugar caused by insulin resistance.

 

Emotional disturbances

 

 

Increased risk of depression, anxiety and eating disorders.

Due reduced body confidence and abnormal reproductive hormone balance , including increased estrogen.

 

 

Complications

Due to the bodily changes that occur from the mechanisms of PCOS, there are some complications that those with  PCOS may have an increased risk for conditions such as:

  ~ Type 2 diabetes

  ~ Infertility or recurrent miscarriages

  ~ Depression

  ~ Heart Disease

  ~ Fatty Liver 

 

    Causes

    PCOS is a diverse condition associated with several genetic and environmental factors. Whilst the name implies that there is an apparent dysfunction of the ovaries, these symptoms are actually due to metabolic and hormonal dysfunctions which are then causing the trouble and not the other way around. (Tricky, 2011). The major players here in order of prevalence are:

      ~ Insulin Resistance

      ~ Ovarian dysfunction

      ~ Adrenal gland dysfunction

      ~ Hypothalamic - pituitary gland dysfunction

      The majority of women with PCOS have insulin resistance, which directly causes increased abdominal fat (which also increases estrogen levels) and directly effects steroid hormone metabolism - particularly androgens.

      Many with insulin resistance have a genetic predisposition, which means they are more susceptible to the condition particularly when engaging in a diet that is moderate to high in refined sugar with a lack of physical activity. Other causative factors of insulin resistance include some medications (e.g. corticosteroids, valproate) smoking, pregnancy, and aging.

      Defects of the adrenal glands can also contribute to insulin resistance due to continuous high levels of the stress hormone cortisol. Adrenal dysfunction can be caused by high levels of sustained stress, medications and in rare cases adrenal tumors. 

       

      PCOS and Adult Acne

       As you would now know, the process in which PCOS causes acne is due to 1) increased insulin and 2) increased androgens. The cascade of events that lead to increased androgens and elevated insulin create an environment for acne to form. High levels of testosterone and dhea-s cause an increased production of sebaceous gland activity and increased hair growth. Because the hair follicles in PCOS are coarser, this can increase the chance of pore blockage. These blocked pores, called “comedones” can become inflamed either to the presence of troublesome bacteria or from tissue damage (picking and squeezing). Androgens can also alter the consistency of skin cells making them kind of sticky, thereby when they shed they are more likely to accumulate and block pores.

       

      PCOS & Acne Management 

      Alas. PCOS does not have to be a (menstrual) life sentence. Treatment plans from health practitioners are available, whether you opt for the GP approach or natural therapist. To manage the acne caused by PCOS it means addressing the underlying causes of insulin resistance and androgen excess. 

      GP Approach

      The allopathic medical approach can provide you with diagnostics such as hormone profile, ultrasound and oral glucose tolerance test. Treatment options  include the oral contraceptive pill (to block androgen effects), Insulin sensitizers such as Metformin or thiazolidinediones (to reduce insulin resistence) Spironolactone (an androgen blocker), and possibly topical antibiotics or a benzoin cream to apply topically to the acne. 

      Naturopathic Approach

      To address the underlying cause of insulin resistance a dietary and lifestyle plan that involves a low GI diet with help planning time for physical activity is fundamental. 

      A tailored individual herbal medicine script will also be provided that helps to regulate blood sugar, reduce androgen excess via the adrenal glands and ovaries, and support the liver in clearing excess sex hormones from the body. Nutritional and herbal considerations may be included to help support overall healthy skin via collagen support and immunity . 

      Management of other aggravating factors that can affect insulin and hormones such as stress and sleep should also be addressed. 

       

      Just because you are a female experiencing adult acne acne. There are many other possiblities, so check with your health practitioner to find out what could be the reason for you. 

       

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      References
      Boyle, J Teede, HJ 2012, Polycystic Ovarian Syndrome: An Update, Australian Family Physician, vol.41, no.10 pp.752-756.
      Teede, H Stuckey, BGA 2007, Polycystic Ovarian Syndrome Sydrome and Abnormal Glucose Tolerance, , Med J Australia, Vol. 187, No.6, pp.324-325.
      Jialal, I Naiker, P Reddi, K 1987, Evidence For Insulin Resistance In Non Obese Patients With Polycystic Ovarian Disea, J Clin Endocrinol Metab, Vol.64, No.5, pp.1066-1069.
      Tricky, R 2011, Women, Hormones & The Menstrual Cycle 3rd Edition, Tricky Enterprises, Melbourne, Victoria.

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